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Risk ratios (RR) and 95%\u2009CI were calculated and pooled for analysis. Analysis was stratified according to gestational age at commencement of treatment (\u2264\u200916\u2009weeks <jats:italic>vs<\/jats:italic> &gt;\u200916\u2009weeks) and subgroup analysis was performed to assess the impact of aspirin dose (&lt;\u2009100\u2009mg <jats:italic>vs<\/jats:italic> \u2265\u2009100\u2009mg). Meta\u2010regression was used to assess the impact of LDA on perinatal outcome, independent of the reduction in PE, preterm birth and low birth weight.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty studies involving 34\u2009807 participants were included. When LDA was commenced \u2264\u200916\u2009weeks' gestation, it was associated with a significant reduction in the risk of perinatal death (RR, 0.47; 95%\u2009CI, 0.25\u20130.88; <jats:italic>P<\/jats:italic>\u00a0=\u20090.02; number needed to treat, 92); however, this risk reduction was only seen when a daily dose of \u2265\u2009100\u2009mg was administered. If commenced &gt;\u200916\u2009weeks' gestation, LDA was associated with a significant reduction in 5\u2010min Apgar score &lt;\u20097 (RR, 0.75; 95%\u2009CI, 0.58\u20130.96; <jats:italic>P<\/jats:italic>\u00a0=\u20090.02) and periventricular hemorrhage (RR, 0.68; 95%\u2009CI, 0.47\u20130.99; <jats:italic>P<\/jats:italic>\u00a0=\u20090.04), but a trend towards an increase in the risk of placental abruption (RR, 1.20; 95%\u2009CI, 1.00\u20131.46; <jats:italic>P<\/jats:italic>\u00a0=\u20090.06) was also noted. LDA was not associated with any significant increase in adverse events if commenced \u2264\u200916\u2009weeks gestation. LDA had no effect on delivery mode, irrespective of the gestational age at which it was started. Meta\u2010regression confirmed that the effect of LDA on perinatal death, when treatment was started \u2264\u200916\u2009weeks' gestation, was independent of any reduction in the rate of PE and preterm birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LDA improves some important perinatal outcomes, without increasing adverse events such as placental abruption or periventricular hemorrhage, and its utility, if commenced prior to 16\u2009weeks' gestation, may be considered in a wider context beyond the prevention of PE or fetal growth restriction. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20859","type":"journal-article","created":{"date-parts":[[2019,9,3]],"date-time":"2019-09-03T19:50:00Z","timestamp":1567540200000},"page":"157-169","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Impact of low\u2010dose aspirin on adverse perinatal outcome: meta\u2010analysis and meta\u2010regression"],"prefix":"10.1002","volume":"55","author":[{"given":"J. M.","family":"Turner","sequence":"first","affiliation":[{"name":"Mater Research Institute, University of Queensland  South Brisbane Queensland Australia"},{"name":"Faculty of Medicine The University of Queensland  South Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. 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